PowerPoint presentation by NYLAG for webinar to be conducted on August 26, 2025 about the new ADL restrictions. Read about the ADL restrictions at http://health.wnylc.com/health/news/85/. Sign up for the webinar at https://nylag-org.zoom.us/webinar/register/WN_IzcIbiZdTCOJrI-F6AOb6A#/registration.

NYLAG testimony being presented at public legislative hearing on August 21, 2025 regarding the transition to a Single Fiscal Intermediary (FI) (PPL). Link for live streaming https://www.nysenate.gov/calendar/public-hearings/august-21-2025/joint-public-hearing-consumer-directed-personal-assistance - see

NYS Dept. of Health Reference Manual used to train nurses in using the Uniform Assessment System tool. This tool is used by the NY Independent Assessor as well as by plans and local DSS to assess functional need for personal care and CDPAP services.

Comments filed by NYLAG opposing the cap on enrollment proposed by DOH in https://health.ny.gov/facilities/long_term_care/nhtd/reference/docs/NHTDAmendmentDraft2025.PDF.

Comments filed on the NYS DOH Phase-out plan for MAP integrated hearings starting Jan. 1, 2026, which can be found at https://www.health.ny.gov/health_care/managed_care/mltc/docs/phase-out_plan.pdf

July 12, 2012
The purpose of this ALERT is to inform Community Based Organizations, Client Representatives, Certified Home Health Agencies and other providers that the Medical Assistance Program is changing the way it processes Medicaid applications for excess income eligible consumers seeking enrollment into a Managed Long Term Care (MLTC) plan. Consumers seeking MLTC enrollment who are found to only be eligible for the Medicaid Excess Income (Surplus) Program will now have their cases accepted and authorized with “06” (provisional) coverage. This will occur even if their applications are received without bills that cover their excess or surplus.

This new process will allow MLTCplans to see the provisional coverage on ePaces/eMedNY and will facilitate receipt of services for these consumers. Submitters are requested, when appropriate, to prominently indicate on the cover sheet of submitted applications that the consumer intends to enroll into an MLTC plan

Current policy will remain unchanged for all other consumers found eligible for the Excess Income Program.

PPL's Official form for a Personal Assistant who receives Medicare to opt out of the PPL BasicWellness plan, which is otherwise mandatory (only offered in NYC, Long Island & Westchester). PPL has a second plan called "Minimum Value" plan, but PAs may simply opt not to enroll in this plan. At this time, only Medicare beneficiaries may decline the BasicWellness coverage. Note that new form says to submit the form with copy of Medicare card thru the PPL Portal. See more about PPL health insurance at http://health.wnylc.com/health/news/97/#WAGES%20+%20BENEFITS.

NYLAG update presented in the 30th Elder Law Forum on May 15, 2025 sponsored by Pierro, Connor & Strauss LLP. Recording of this presentation will be posted soon. View PDF that includes all presentations at https://www.pierrolaw.com/wp-content/uploads/2025/05/Elder-Law-Forum-Presentation-2025.pdf.
TOPICS in this presentation:
1 -NYC Medicaid Cases Closing if Renewals Not Returned – 20,000 in first batch!
2- CDPAP Transition to PPL as Single “FI”
---Status, advocacy, health insurance, what is driving this?
3 -Recent & Upcoming MLTC Plan Mergers – Alert re Transition Rights
4 NYS Fair Hearing Backlog- “PHD” process 2025
5 Federal Medicaid Defense
6 On the horizon
---MECM – Medicaid applications moving online!
---Pending Home Care Restrictions passed in 2020 (Lookback, ADL Thresholds)

Fillable version of form for CDPAP personal assistant to request an exception from PPL allowing use of paper timesheets after May 17, 2025, when the blanket exception ends. Official form is at https://pplfirst.com/wp-content/uploads/2025/04/Paper-Timesheet-Exception-Form.pdf. Fillable version of paper timesheet can be found at http://health.wnylc.com/health/download/890/

NEW Fax numbers for Home Care Services Program at NYC HRA Medicaid CENTRAL INTAKE, Use for
submission of NYIA decision "OUTCOME" otfices for adult applicants if NYIA denied MLTC enrollment and refers back to local district to request HOUSEKEEPING services (limited to 8 hours/week), and to submit M11Qs for applicants under 18,  and to submit change requests on active cases, and reauthorizations of CASA cases.